*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
Drafting a sound financial plan is challenging to an individual for reasons more than one. The primary aim of the plan is to cater for financial cover for life goals and long term wealth creation in the form of a healthy financial corpus to ensure a contented retired life for self and family alike. The front runner tool in this exercise is the different types of life insurance plans, serving the purpose of meeting individual needs, both in the short and long terms. Life insurance plans look after the protection of the family as well as long term money growth.
However, uncertainty prevails in the area of healthcare, the need for, which can hardly be predicted. Any medical condition that warrants hospitalization and long term treatment can make a dent in one’s savings and ruin the basis of any financial plan. Coupled with the unpredictability of medical emergencies, it is the double-digit healthcare inflation that is worrisome, as compared to single-digit inflationary impact in other means of sustenance. A suitable comprehensive health insurance is a sensible solution to counter this deficiency. Once the insurance sector was liberalized in 2000, there was an influx of global insurance players into the country. The outcome was not only felt in innovative life insurance products but also innovative Health Insurance products in sync with the needs of modern Indian society, which provided a huge market for best health insurance in India. With a market potential of 1.3 billion Indians waiting to be covered, health insurance plans in a spectrum of hues became a reality, both in the portfolio of Life and General Insurers.
Health insurance is a special insurance product designed to cover the medical and surgical expenses of the insured. It takes care of all the medical expenses arising out of illness or injury by paying directly to the caregiver like hospitals and clinics or reimbursing them subsequently.
Best health insurance can be described as a cover for future medical expenses of the insured. By definition, it is an agreement between the insurer and the insured, where the former guarantees to compensate for medical costs if the latter is hospitalized due to illness or injury. Insurers have tie-ups with a network of hospitals to provide seamless cashless treatment experience to the insured.
Usually, health insurance falls in the domain of General Insurance, as life risk cover is not involved. Other than General Insurance Companies, Health Insurance is also offered by Life Insurance companies in India. Thus, comprehensive health insurance cover is a critical financial tool for the individual.
Having understood what medical insurance is all about, it is to summarize the reasons why choosing the best health insurance policy makes sense.
Health insurance funds medical emergencies of the insured, which is a daunting task in the present healthcare scenario in the country. Any worthy health insurance policy is flexible to cover a range of diseases and surgical procedures, with certain plans covering up to 30 critical illnesses and 80 surgical procedures, respectively. On top of that, the best health insurance plan pays for the medical expenses regardless of the cost within the limit of sum insured, and the policy continues for the full term, even after the benefit is paid. It needs an in-depth look at the different plans aspiring to be the best health policy in India.
The individual plan extends coverage to a single individual for meeting medical emergencies.
This is a single plan where health coverage is extended to the entire family comprising of a spouse, dependent children, or sometimes parents and other relations. The sum insured can be used singly or severally for the entire amount.
Senior Citizen Plans are specially designed to cater to the health insurance needs of senior citizens, i.e., persons above 60 years of age.
It is a standalone plan, unlike a Critical Illness Rider designed to cover specific ailments considered critical. The number of ailments like renal failure, heart attacks, stroke, or even cancer varies with insurers.
Personal Accident Plan covers for hospitalization due to injuries caused in an accident.
A maternity plan is designed to cover pregnancy and childbirth. The newborn is also covered up to a certain age.
As the name suggests, these are dual-purpose plans providing health cover in addition to the creation of a corpus of added coverage.
This defined plan offers a daily cash allowance during the stay in the hospital, as well as convalescence. The range and scope may vary with insurers.
This plan caters to the healthcare needs related to the specific disease. Some examples are Cancer care, Heart care, or even Dengue care, etc., to name a few.
These are plans, which work on the principle of the deductible. It helps to substantially increase the cover amount over and above a base health insurance policy. The other important benefit is that this plan can be bought for the fractional cost of the base policy.
It is designed to manage health better in chronic conditions based on medical, behavioural and lifestyle factors.
The first thing one need to fathom is the different terminologies used in health insurance. Until and unless one is well conversant with the jargon, it will not be possible to comprehend what is of offer and check various inclusions and exclusions. It is thus imperative to decipher what the terms mean and its implications.
Normally, health insurance or Mediclaim comes into play once the insured is hospitalized. However, immense technological advances in healthcare permit many procedures and treatments to be performed in facilities of Day Care in less than 24 hours, where overnight stay in the hospital is not necessary. A typical example is Dialysis. Best Medical Insurance Policy will invariably cover several procedures for Day-care cover. Bigger the list, better it is.
It is a provision by, which the incurred benefit is restored using a refill during the policy term so that the sum insured remains unchanged. Restoration of Benefits is permitted up to 100% in a year. However, the premium cost for such plans are higher.
It is a situation where treatment is warranted in a hospital in the normal course but is compelled to be undertaken at home. The reasons can be:
It is an alternative treatment that some health insurance accommodates. It is an acronym for Ayurveda, Unani, Siddha, and Homeopathy.
Many health insurance plans incorporate the clause, which mandates bearing a percentage of the claim amount by the insured. While it lowers the premium, co-payment may make a dent in one's savings.
It is similar to claim the discount, where the sum insured increases by 5% every claim-free year. However, such a cumulative bonus can enhance the sum insured to only a percentage of the base amount in most plans.
It is the other name of loss borne by the insured. It is normally a percentage of the claim amount or a fixed sum, as in the case of Top-Up policy. Higher the deductible, lower the premium.
It is the timeline compulsorily imposed to admit the cover for pre-existing diseases. The period can be as high as 48 months, which most insurers impose.
It is the amount of cover or pay-out, either paid directly to the caregiver or reimbursed. If a policy has a cover of Rs, 5 Lakh, and the hospital claim is Rs 2 Lakh, then Rs 2 Lakh is paid, and the fresh cover is Rs 3 Lakh for the remainder of the policy term.
It is an acronym for Third Party Administrator, which is a body that processes claims under a mediclaim policy. They are either independent or belong to an insurer. They operate under license of IRDAI and facilitate cashless treatment in networked hospitals, where they maintain their desk.
Below is the list of the best health insurance plans in India in 2020:
Insurance Provider |
Network Hospital |
Incurred Claim Ratio |
Plan Options |
Sum Insured (Rs) |
5850+ |
59% |
Active Assure Diamond |
2 Lakh-2 Crore |
|
6500+ |
85% |
Health Guard |
1.5 Lakh-50 Lakh |
|
4300+ |
89% |
Smart Health Super Insurance |
5 Lakh-1 Crore |
|
Care Health Insurance (formerly known as Religare Health Insurance) |
4987+ |
55% |
Care Health Plan |
2 Lakh-10 Lakh |
6500+ |
35% |
Classic Family Health Insurance |
2 Lakh-5 Lakh |
|
5900+ |
11% |
Digit Health Care Plus Insurance |
Up to 3 Crore |
|
2578+ |
115% |
Edelweiss Health Insurance |
1 Lakh- 1 Crore |
|
5000+ |
73% |
Criticare Plan |
20 Lakh & 50 Lakh |
|
4721+ |
62% |
Health Optima Restore |
3 Lakh-50 Lakh |
|
5000+ |
102% |
Health Protector Plus |
2 Lakh- 25 Lakh |
|
4800+ |
47% |
Kotak Health Premier |
- |
|
3000+ |
82% |
Health Connect Supra Top-up |
Up to 1 Crore |
|
4115+ |
54% |
Companion Individual Plan |
4 Lakh -1 Crore |
|
6500+ |
62% |
Pro Health Select |
2 Lakh- 25 Lakh |
|
4500+ |
107.64% |
National Parivar Mediclaim |
1 Lakh-10 Lakh |
|
3000+ |
103.74% |
Senior Citizen Mediclaim |
1 Lakh-1.5 Lakh |
|
4300+ |
108.80% |
Individual Mediclaim Policy |
1 Lakh-10 Lakh |
|
2000+ |
33% |
Health QBE |
1 Lakh-50 Lakh |
|
5000+ |
61% |
Lifeline Supreme Plan |
5/10/15/20/50 Lakh |
|
4000+ |
14% |
Critical Illness Plan |
5/7/10 Lakh |
|
9800+ |
63% |
Family Health Optima |
4 Lakh and 5 Lakh |
|
6000+ |
52% |
Arogya Premier |
10 Lakh-30 Lakh |
|
4000+ |
78% |
TATA AIG MediPrime |
2-5 Lakh, 7. 5 Lakh and 10 Lakh |
|
7000+ |
110.95% |
UNI Criticare Plan |
1/3/5/10 Lakh |
|
5000+ |
92% |
Individual Health Insurance |
7.5/10/12.5/15 Lakh |
Disclaimer: *Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
The key to choosing the best health insurance lies in understanding the features that one is likely to get from a particular plan. Meticulous analysis of all the features helps in making an informed choice to ensure adequate coverage to protect the family from the uncertainty related to a health emergency.
The usual age range for purchase of health insurance policy is 18 to 65 years
Most of the insurers offer the facility of lifetime renewal, which ensures cover until a very ripe age
A suitable Mediclaim or health insurance policy provides just the requisite cover for meeting the cost of medical emergency without depleting family savings. Healthcare costs typically lead to heavy erosion of financial resources, until covered by medical insurance.
Health insurance provides for both cashless treatment as well as reimbursement of medical expenses, typically related to hospital treatment. Insurers offering health insurance have a wide network of hospitals to facilitate cashless treatment, which turns out to be highly convenient.
A large number of Network Hospitals ensures seamless cashless treatment.
Insurers sometimes enhance the sum insured for years when there is no claim. No claim bonus can also be cumulative, provided there are consecutive no-claim years.
Generally, insurers provide a facility for free health check-ups as an incentive for no claim years.
It is a pre-policy feature with the varying age range for the issue of the policy document. Generally, it is waived for individuals till 45 years of age, for some insurers, the age is higher at 55 years.
It allows global coverage for planned and emergency cashless hospitalization.
Surgical procedure for an organ transplant as an add-on with a customized cover.
Before buying a health insurance policy in India, one must be well-aware of the core benefits offered by that plan. Some of the key benefits of the best health insurance policies in India are as follows:
It is typically covered in health insurance, but may not be so in Mediclaim. The number of days for, which cover is provided is in the range of 30 to 90 days. It covers OPD, Doctor’s consultation, Diagnostic Test costs, and medicines.
These are covered by health insurance, with their limits varying. Some insurers provide for limits based on the percentage of the sum insured. These impact the overall cost of reimbursement as they are interlinked. It is wise to opt for liberal rent features rather than limited ones.
The feature related to listed Critical illness varies in the pay-out of health insurance. A lump sum amount equivalent to the sum insured is paid out on the diagnosis of the critical illness regardless of the incurred medical expenses.
The best health insurance policy offers several add-on covers, including loss of income due to accident.
The best health plan will also offer comprehensive maternity coverage both in pre and postnatal stages, including childbirth and insurance for the newborn for a limited period. However, there is a waiting period of 9 months.
It is admissible for cashless as well as reimbursement of medical expenses.
Ambulance charges are reimbursed subject to certain limitations.
Some plans provide daily cash allowance during the period of hospitalization. Additionally, it is also provided for convalescence. The quantum and number of days to be covered can differ with plans.
The health insurance premium is considered for tax saving deduction under Section 80D as per IT Act, 1961. The eligibility for the deduction pertains to self, spouse, dependent children and parents, with the quantum related to age.
Deduction under Section 80D for FY 2019-20 (AY 2020-21) |
|||
Situation |
Self and dependent |
Parents |
Total deduction |
Under 60 Years |
Rs 25,000 |
Rs 25,000 |
Rs 50,000 |
Self under 60 + Parents Over 60 years |
Rs 25,000 |
Rs 50,000 |
Rs 75,000 |
Both over 60 years |
Rs 50,000 |
Rs 50,000 |
Rs 1,00,000 |
Most Indian customers are clueless about the difference between Mediclaim and Health Insurance, often making the mistake of equating them. In everyday parlance, it may seem to be the same, but they differ in many ways. A proper understanding of them is imperative when it comes to buying the right plan for meeting medical emergencies in harmony with the family health profile.
It is a health cover for illness, surgery, or accident for treatment undertaken in hospital primarily, but also permits domiciliary care in certain circumstances. Broadly, Mediclaim confines itself to hospitalization or Nursing home treatment.
It is a comprehensive health cover accommodating medical expenses for illness, surgery, and accident beyond basic hospitalization. Thus it caters to pre and posts hospitalization medical expenses, ambulance charges, Day Care treatment, OPD treatment, Critical illness cover and many more expenses related to medical emergencies.
Comparison between Mediclaim and Health Insurance |
||
Parameters |
Mediclaim |
Health Insurance |
Coverage |
Hospitalization expenses for a limited period for illness and accidents |
Comprehensive cover besides Hospitalization for a longer period for Daycare, OPD, Diagnostics, etc., |
Add on Cover |
None |
Critical illness, maternity |
Benefits |
Depends on Insurer |
Uniform across most insurers |
Sum insured |
Up to Rs 5 Lakh |
May be in Crores |
Claims |
Till sum insured is exhausted |
Until sum insured is exhausted and in critical illness, one-time payout. |
Hospitalization |
Compulsory |
Daycare, OPD, Domestic Hospitalization is also covered |
Premium |
Generally low |
Higher due to greater coverage |
Flexibility |
Low |
High covering multiple expenses and customized options |
The final verdict on Mediclaim vs. Health insurance is a difficult proposition, considering all the aspects. It is heavily dependent on individual needs. If the aim is an immediate cover for medical emergencies, Mediclaim may suffice. However, comprehensive cover for Spouse, dependent children, and parents can be provided only by Family Floater Health Insurance for flexibility and customization.
While it is a good idea to identify the Best Health Insurance Plans in India, it has to be remembered that the selection is only in relative terms and not absolute. It is a fact that there is no dearth of different health insurance plans in India. Yet, each plan has something unique or new to offer, across all insurers. Added to that is the geographical presence, which can influence the purchase from a particular insurer only. In such circumstances, it is logical to study the entire range of health insurance policies in India both for academic interest and to make an informed choice. Accordingly, a collection of health insurance across all insurers operating in India is appended below. It has to be importantly noted that health insurance is a non-life insurance product, is designed and marketed by the General Insurance Companies exclusively, or the General Insurance arm of Life Insurance companies. There are a few exceptions, where Life insurance companies also offer health insurance products.
Aditya Birla Sun Life Insurance |
|
Plan Name |
Key highlights |
Cancer Shield |
Covers all stages of cancer with level or increasing cover facility |
Hospital Plus |
Offers fixed cash amount on hospitalization with choice of 4 benefit options |
CritiShield |
There are 5 benefit options to choose from for cover extending to major critical illnesses. |
Apollo Munich Health Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Optima Restore |
It offers coverage from Rs 3 Lakh to Rs 50 Lakh with restoration and multiplier benefits. |
Easy Health |
It is an affordable plan with a cover-up to Rs 15 Lakh but providing for all the benefits like Daycare, Domiciliary treatment, Daily cash, to name a few. |
Health Wallet |
In a revolutionary concept covering up to Rs 50 Lakh, the sum insured is carried forward to the next policy year with a 6% increase at 50% of the premium. |
Easy Health - Family |
It is a comprehensive cover plan for the young family with a sum insured up to Rs 50 Lakh and all usual inclusions. |
Easy Health - Premier |
Coverage in the range of Rs 4 Lakh to Rs 50 Lakh offering all the inclusions, including maternity expenses and newborn cover. |
iCan Cancer Insurance |
Sum insured from Rs 5 to Rs 50 Lakh covering all aspects of cancer treatment, including follow-up care. |
iCan Dengue Insurance |
Comprehensive and exclusive cover for Dengue treatment, including OPD expenses. |
Optima Cash |
It is a daily cash benefit plan covering all hospital procedures as well as convalescence. |
Maxima |
It is a comprehensive plan that covers every little expense, which includes doctor fees, pharmacy, diagnostics, spectacles, contact lenses, dental treatment, and health check-ups |
Optima Super |
It is an aggregate top-up plan with coverage extending to all the usual features |
Optima Vital |
It is a critical illness plan covering 37 diseases with cover up to Rs 50 Lakh as lump sum payment on the diagnosis. |
Energy |
It provides comprehensive cover for diabetic individuals with a cover-up to Rs 50 Lakh and all usual inclusions. |
Bajaj Allianz General Insurance Co. Ltd. |
|
Plan Name |
Key highlights |
Individual |
A comprehensive plan with multiple sums insured and all usual inclusions like maternity and the newborn |
Health-Guard |
Plan for self and family providing holistic coverage with all the usual benefits in health insurance |
Infinity Plan |
There is no limit in sum insured in multiple policy term options and lifetime renewability. |
Critical Illness |
Multiple sums insured options covering individual and family ensuring 100% payout on diagnosis of critical illness. |
Extra Care Plus |
It is a top-up plan designed for extra coverage with entry age up to 80 years |
M-Care |
Protection plan for health risks arising out of vector-borne diseases. |
Arogya Sanjeevani |
IRDAI promoted health insurance for the entire country |
Health Care Supreme |
A comprehensive health plan with an add-on of critical illness, accident, and ancillary expenses benefit. |
Hospital Cash |
Daily cash allowance with additional accompanying benefits. |
Some of the other plans from the company are Silver Health, Star Package, Health Ensure, Tax Gain, Personal Guard, Critical illness for Women, Premium Personal Guard, Extra care, Global Personal Guard, etc. |
Bharti AXA General Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Smart Super Health |
Cover up to Rs 1 Crore with 100% restoration benefits and an option for critical illness and hospital cash. |
Smart Health Assure |
Lifelong cover with 130 Daycare treatments, maternity, and critical illness benefit. |
Care Health Insurance (formerly known as Religare Health Insurance) |
|
Plan Name |
Key highlights |
Care Health Care |
Comprehensive cover for individuals and families with modern treatments like Robotic Surgery and HIV / AIDS. |
Care Health Care Freedom |
It is a diabetes insurance plan with lifelong renewability and annual check-up along with the restoration of benefit |
Care Health Care Heart |
It is comprehensive coverage for heart care with the facility for an international second opinion and cardiac health check-up. |
Care Health Care Senior |
It is designed for senior citizens with higher insured amounts and health check-ups to promote a healthy lifestyle. |
Care Health Joy |
It is maternity insurance with a 9 months waiting period and newborn cover with a long tenure of 3 years |
Care Health Cancer Insurance Plan |
Covers all stages of cancer with lifelong protection at affordable prices. |
Care Health Critical illness Insurance |
It covers 32 major critical illnesses, including Day Care and OPD expenses. Unlimited ICU charges and global coverage is another essential feature. |
Care Health Heat Care Mediclaim |
The coverage extends to 16 major heart ailments and even in case of relapse. |
Care Health Operation Mediclaim |
It is a low premium high coverage policy for all defined surgical procedures. |
Care Health Care Enhance |
It is a top-up policy offering cover up to Rs 30 Lakh and deductible up to Rs 10 Lakh. All other covers match the base health insurance plan. |
Cholamandalam MS General Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Healthline |
It is a hospitalization plan with 4 variants – Value, Freedom, Enrich, and Privilege. With inbuilt daycare and Domiciliary hospitalization of 7 days. |
Critical Healthline |
There are 2 plans, Standard and Advanced, with cover for 10 and 12 critical illnesses, respectively. Lifetime renewal, family cover, and flexible sum insured facility are the others |
Hospital Cash Healthline |
Daily cash amount for each day in the hospital and convalescence benefit limited to a continuous period of 20 days. Choice of 6 plans and flexible policy term up to 3 years |
Super Top-up |
To meet higher medical expenses, both for the individual and family. Offers 2 plan options Premier and Supreme with wide choice spanning sum insured and deductibles. |
Future Generali India Insurance Co. Ltd. |
|
Plan Name |
Key highlights |
Health Total |
It is comprehensive medical insurance for individual and family in 3 options – Vital, Superior and Premier |
Accident Suraksha |
It is a personal accident death and permanent disability cover policy with repatriation and funeral benefit. |
Vector Care |
It is for protection against mosquito cased Dengue, malaria, etc. Sum insured range is Rs 10000 to Rs 75000 |
Hospcash |
It is a hospital cash plan with 3 options for sum assured based on monthly income. |
Arogya Sanjeevani |
It is a standard insurance plan designed by IRDA for pan India uniformity and sum insured of maximum Rs5 Lakh. |
Criticare |
A critical illness policy with 2 sum insured options of up to Rs50 Lakh for 45 years and lower and Rs20 Lakh for 45 to 65 years of age. |
Surakshit Loan Bima |
It is designed for the protection of borrowers of banks and other financial institutions with critical illness and accident-related cover up to Rs 3 Crore in 5 plan variants. |
Health Surplus |
It is top-up health insurance aimed to enhance the sum insured at an affordable cost. |
Advantage Top-up |
It is deductible top-up health insurance to augment total cover. |
Health Suraksha |
There are 4 different variants of this plan – Gold, Platinum, Topaz, and Ruby for both individuals and family. |
Arogya Bima |
It is affordable health insurance coverage from 1 to 70 years of age, with a maximum sum insured of Rs 5 Lakh. |
Varishta Bima |
It is a senior citizen's health insurance to cover from 60 years to whole life. The maximum sum insured is Rs 1 Crore. |
HDFC ERGO General Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Individual |
There are 4 options – maximum sum insured of Rs 5 Lakh, Rs15 Lakh, Rs 75 Lakh, and top-up to supplement the health plan. |
Family |
Same 4 options – maximum sum insured of Rs 5 Lakh, Rs15 Lakh, Rs 75 Lakh, and top-up to supplement the health plan. , |
Parents |
3 options – maximum sum insured of Rs 5 Lakh, Rs15 Lakh, and top-up to supplement the health plan. |
Senior Citizen |
3 options – maximum sum insured of Rs 5 Lakh, Rs15 Lakh, and top-up to supplement the health plan. |
My: Health Women Suraksha |
Comprehensive plan designed specifically for women related surgeries and major illnesses. |
Critical illness |
Cover for 15 critical illnesses in 2 plan options. Flexible policy term up to 2 years and lump sum payment on the diagnosis. |
My: Health Medisure Super top-up |
Cover can be enhanced up to Rs 20 Lakh. |
ICICI Lombard General Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Complete Health Insurance |
Cover for the whole family with whole life renewability and protection |
Personal Protect |
Worldwide cover for accidental death and accidental permanent disability. |
Health Booster |
Sum insured from Rs5 Lakh to Rs 50 Lakh with lifetime renewal and floater option. |
IFFCO Tokio General Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Family Health Protector |
Comprehensive family health covers with 161 Daycare procedures, daily cash, critical illness, AYUSH, and vaccinations. |
Individual Health Protector |
Comprehensive individual health covers with 161 Daycare procedures, daily cash, critical illness, AYUSH, and vaccinations. |
Swasthya Kavach |
A family floater with cover for children from 3 months to 23 years Daily cash and domiciliary hospitalization are the other covers |
Individual Med shield |
Up to 121 days of care, surgeries are covered along with usual hospitalization expenses. |
Individual Personal Accident |
Covers loss of employment, eyesight, limbs, and permanent disability. It also covers children's education and incremental sum insured every policy anniversary. |
Critical illness |
Lump-sum payment on diagnosis and critical injury along with daily cash allowance. |
Health Protector Plus |
Individual and family floater in 8 plan options along with top-up additions and waiver of deductibles. |
Swasthya Raksha Bima |
Affordable insurance targeted at smaller towns with usual health insurance coverage but with co-pay in Zone A. |
MOS-BITE Protector |
It is designed to cover against 7 vector-borne diseases with a maximum sum insured of Rs 1 Lakh paid on hospitalization of a minimum of 48 hours |
Critical Illness Benefit |
Covers 25 critical illnesses with a maximum sum insured up to Rs 1 Crore. |
Manipal Cigna Health Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Prohealth Select |
Plan with an automatic extension on the diagnosis of critical illness with cover up to Rs 25 Lakh. |
Arogya Sanjeevani Policy |
Basic health insurance designed by IRDAI for a uniform pan India plan with the sum insured up to Rs 25 Lakh |
Prohealth Cash |
Daily cash amounting to Rs 500 to Rs 5000 to compensate expenses beyond health insurance. Companion Benefit of 50% additionally. |
Lifestyle Protection – Critical Care |
Cover for 15 and 30 critical illnesses in Basic and Enhanced Plans. Cover up to Rs 25 Crore and 2 claim payout options. |
Lifestyle Protection – Accident Care |
Choice of 3 plans to receive 200% of sum insured on Accidental Death or Permanent Disability with worldwide coverage. |
Super Top-up |
As a supplement to basic health insurance to enhance sum insured with added features. |
Group Health Insurance Plans – Global Health, Lifestyle Protection, Prohealth, and Overseas Travel |
Max Bupa Health Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Health Companion |
It is a family health insurance plan covering all daycare treatments, and there is no room rent cap for policies over Rs 5 Lakh. |
CoActive |
It is a family health insurance plan with cover up to Rs 25 Lakh. It also offers up to 10 OPD consultations in a policy year. |
Health Premia |
It is a comprehensive individual and family health insurance plan, especially matching with lifestyle. There are 3 variants Silver, Gold, and Platinum, with covers to the highest of Rs 3 Crore. |
Heartbeat |
The plan offers coverage up to Rs 1 Crore with global validity. Additionally, it extends maternity and newborn cover and beyond hospital coverage |
Accident care |
It is a comprehensive accident insurance plan that provides international coverage up to Rs 2 Crore, ideally suited for the individual and the family. |
Criticare |
It is a Critical Illness insurance policy for both the individual and the family. It offers worldwide coverage with a sum insured up to Rs 3 Crore. |
Health Recharge |
It is a top-up plan specially meant for a family floater with the flexible enhancement of sum-insured options. |
Money Saver |
It is a combination of Health Companion and Family Floater Health Recharge with great benefits for the entire family with lifelong renewability. |
New India Assurance Co. Ltd. |
|
Plan Name |
Key highlights |
Arogya Sanjeevani Policy |
Individual and Family Floater plan with the sum insured up to Rs 5 Lakh. |
Asha Kiran |
Individual and Family Floater with accident cover |
Cancer Guard Policy |
Sum insured in the range of Rs 5 Lakh to Rs 50 Lakh depending on age. |
Floater Mediclaim |
Sum insured up to Rs 15 Lakh with cover for 2 to 6 family members |
Mediclaim Policy |
Lifelong renewal for sum insured up to Rs 15 Lakh. |
Premier Mediclaim Policy |
Individual and family plan in two options with a sum insured Rs 15 to Rs 25 Lakh and Rs 50 to Rs 1 Crore, respectively. |
Top-up Mediclaim |
It supplements the basic health insurance with a higher sum insured. |
National Insurance Co. Ltd. |
|
Plan Name |
Key highlights |
Mediclaim Plus Policy |
A high sum insured individual policy with 140+ daycare cover |
Mediclaim Policy |
An individual policy with 140+ daycare cover |
Overseas Mediclaim B&H |
It is a complete package for 3 classes travelling abroad – Business and Holiday, Employment and Study, Corporate Frequent Traveler. |
Oriental Insurance Co. Ltd. |
|
Plan Name |
Key highlights |
Arogya Sanjeevani Oriental |
Individual and Family Floater plan with the sum insured up to Rs 5 Lakh |
Individual Mediclaim Policy |
Sum insured up to Rs 10 Lakh with lifelong renewal facility |
Health of Privileged Elder (HOPE) |
Designed exclusively for senior citizens with the sum insured up to Rs5 Lakh with 20% compulsory co-payment |
Happy Family Floater Policy |
Cover for the entire family with a sum insured from Rs 12 Lakh to Rs 20 Lakh in 3 options – Silver, Gold, and Diamond |
Overseas Mediclaim Policy |
A comprehensive policy with global acceptance for business and holiday |
Jan Arogya Policy |
Covers individuals between 5 and 70 years |
Happy cash Policy |
It is a daily cash benefit policy over and above the sum insured. Women policyholders are paid 25% higher amount |
Super Health Top-up |
It enhances the financial cover of basic health insurance. |
Reliance General Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Health Infinity |
Comprehensive health insurance with cover up to Rs 1 Crore and additional policy term up to 26 months. |
Arogya Sanjeevani |
It is a health plan designed by IRDAI for pan India implementation covering up to Rs 5 Lakh. |
Health Gain |
It is both Individual and Family floater with a 15% discount on premium and auto-refill |
EMI Health Insurance |
A comprehensive plan available in 4 instalments with multiple plan options. |
Personal Accident |
It provides worldwide coverage and increment of the sum insured by 5% every policy year. Covers accidental death, permanent disability, loss of limbs, etc. |
HealthWise |
Comprehensive family health insurance covering daycare, domiciliary hospitalization, critical illness, and daily hospital cash. |
Critical illness |
Covers 10 critical illnesses with policy terms of 1 to 3 years 100% sum insured payment on the diagnosis. |
Royal Sundaram Alliance Insurance Co. Ltd |
|
Plan Name |
Key highlights |
LifeLine |
A holistic health plan is covering both individual and family, offering a 100% refill at no additional cost. Doubling of the sum insured in 5 no claim years and lifelong renewal. |
Family Plus |
A single policy to cover up to 19 relations in a combination of individual and family floater. Covers 200 Daycare procedures and maternity expenses. |
SBI General Insurance Co. Ltd |
|
Plan Name |
Key highlights |
Arogya Premier Policy |
Covers from Rs 10 Lakh to Rs 30 Lakh without any sub-limits and 142 Day Care procedures. |
Retail Health Insurance |
Wide coverage for the entire family from Rs 50000 to Rs5 Lakh with 3 flexible options. |
Critical illness |
Covers 13 critical illnesses in multiple plan options up to Rs 50 Lakh. |
Hospital Daily Cash |
Daily hospital cash Rs 2000 to Rs 4000 per day and convalescence amount of Rs 5000. |
Arogya Sanjeevani |
Covers entire family for sum insured from Rs1 Lakh to Rs 5 Lakh: Ayush and ambulance are extra. |
Arogya Top-up Policy |
Generous cover over and above the base policy up to Rs 10 Lakh. |
Group Insurance Policy |
Individual and family floater cover up to Rs 5 Lakh |
Loan Insurance Policy |
A policy designed for borrowers of SBI to cover for 3 years with Critical Illness, Accidental Death and Accidental Permanent Disability cover. |
Star Health and Allied Insurance Co. Ltd. |
|
Plan Name |
Key highlights |
Comprehensive Insurance Policy—Myself |
Covers entire family with a range of inclusions and restoration of benefit. Dental and Ophthalmology cover on an OPD basis. |
Comprehensive Insurance Policy—Family |
Covers entire family with a range of inclusions and restoration of benefit. Dental and Ophthalmology cover on OPD basis |
Senior Citizens Red Carpet Health Insurance |
Individual and floater plan for senior citizens between 60 and 75 years of age. Guaranteed lifetime renewals. |
United India Insurance Co. Ltd. |
|
Plan Name |
Key highlights |
Arogya Sanjeevani Policy |
Individual and Family Floater plan with the sum insured up to Rs 5 Lakh renewed annually. |
Family Medicare 2014 |
Cover for the entire family including parents and parents-in-law |
Gold |
Apart from the usual, it also covers Day care procedures |
Individual Health Insurance |
Additional cover for Ambulance and Daily Hospital Cash |
Platinum |
Sum insured up to Rs 10 Lakh with cover for certain daycare treatments |
Senior Citizen |
Entry age from 61 to 80 years with a sum insured up to Rs3 Lakh |
UNI Criticare |
Cover up to Rs 10 Lakh paid on diagnosis of listed critical illness |
Top-Up and Super Top-up |
Payable only if the threshold of cover is exhausted with the matching coverage. |
Universal Sompo General Insurance Co. Ltd. |
|
Plan Name |
Key highlights |
Complete Health Care |
Basic, Essential and Privilege Plan |
Super Healthcare |
Option for top-up or Super top-up |
Arogya Sanjeevani |
IRDAI promoted health plan |
Individual Health |
With domiciliary hospitalization |
Individual Accident |
Cover for an accident-related outcome |
Aapat Suraksha Bima |
Lump-sum payment on diagnosis of major ailments |
Loan Secure |
Cover for loan borrowers |
Hospital Cash |
Daily hospital cash allowance including convalescence |
Saral Suraksha Bima |
It is a micro-insurance plan to pay in a lump-sum |
Sampoorna Suraksha Bima |
Comprehensive cover including accidents |
Senior Citizen Health Insurance |
Only for individuals over 60 years with cover for spouse |
Other plans include Pravasi Bharatiya Bima Yojana, Surva Vidyarthi Bima Yojana, Swarna Gramin Bima Yojana - Individual and critical illness |
Health Insurance was introduced in our country for the first time in around 1986. The whole genre has come a long way since then. A quantum jump in the variety and innovative health insurance products took off after liberalization in the insurance sector in 2000. The advent of international insurance players in the Indian market provided the requisite impetus with fresh ideas in the field of health insurance. The low penetration of health insurance helped the sector grow exponentially. Thus, today the customer is spoilt for choice in the variety of health insurance plans. Coupled with the large portfolio of health insurance products, the delivery channels are also far too many, ensuring customer ease. There are thus mortar and brick offices, agents, brokers, and above all, robust portals offering purchase of plans online. Application for best health insurance can be categorized into two – Offline and Online.
The process is not very elaborate and uniform with all the insurers. It can be defined in a few steps.
It is a handy tool, especially patronized by the current generation, because of its inherent advantages and ease of operation. The steps are defined as:
There is no denying reality, that the possibility of falling sick increases with age. Younger people are in lesser need of medical assistance as they are generally healthy. Driven by the same vital logic, the premium for health insurance is lower for younger people rather than when one is older. It is smart to purchase health insurance at an early age to get the benefit of low premiums.
Lifestyle habits play a vital role in determining the cost of the premium. Thus smokers or those who consume alcohol, as a matter of routine, are charged a higher premium for the simple reason that they carry a higher risk of diseases.
It is a ratio derived concerning the weight and height of an individual. A higher BMI signifies an unhealthy lifestyle, resulting in obesity, making one vulnerable to diseases of heart, joint, and diabetes needing frequent medical assistance. The premium goes up for such individuals.
Family history of certain diseases makes one prone to suffer from them, much more than with a clean history. Diseases like cancer, hypertension, and cardiac ailments fall in this category. Individuals with a history of these diseases attract higher premiums.
Persons with pre-existing diseases have to pay a higher premium because the possibility of repeat medical assistance in them is high.
Professional hazards also play a role in determining the cost of the premium. Some professions carry a higher risk of illness, like mining, which calls for higher premiums.
Once conversant with the factors that impact the cost of the premium, the corollary is obviously to save on it reasonably, without compromising on quality. A health insurance plan not only provides to overcome medical contingencies but also protects the savings corpus. Therefore, purchasing health insurance is not only essential but mandatory as well. It is smart as well as wise to find the best ways to mitigate the cost of the premium as far as possible.
Premium is lowest at the early stage in life when there are hardly any medical issues to confront. It is this stage of life, that there practically any need for medical assistance. Yet, it makes sense to purchase one of the best health insurance plans, as the premium is low.
Instead of choosing disease-specific health plans at a higher rate, it is prudent to purchase basic health insurance and opt for riders solely based on specific needs and health profiles.
Since the ambit of cover is for the entire family, it turns out to be beneficial in terms of the cost of the premium as compared to individual plans for each member of the family.
The coverage can be substantially augmented with the help of Top-up policy, at a fraction of the cost of an independent health plan. The trick is to purchase a health plan of reasonable financial coverage and enhance it with a Top-up at a low cost. However, it is preferable to keep deductible out from the chosen Top-up.
Many insurers add to the sum insured based on claim-free years. The increase in percentage is substantial for serious consideration.
It adds to the profile of the customer who is a non-smoker and non-drinker. Most insurers offer a discount to non-smoking customers. Even, the benefit may be availed after one quits smoking during the policy term.
It is the best option, as the low overhead cost is passed on to the customer resulting in a lower premium.
Having understood the absolute necessity of a health plan in one’s life, a simple nagging question, "Which Is the Best Health Insurance Policy," to buy is not unusual. After all, aspiring for the best is a matter of compulsion and not choice in such a crucial protection tool. In this light, there are a few cardinal rules, which can help fulfil the desire to buy the best health insurance plan, which is value for money,
The focus, without doubt, has to be on not compromising on the quantum of cover for the family, and make the best of the premium paid. Any deficiency will cost dearly in the future, as payment goes from the pocket to clear what the plan does not
A large network of hospitals tied up with the insurer helps in a medical emergency if located near the residence. It is ensured by checking out the geographical umbrella of the insurer
It is essential to comprehend the impact of the cover provided, as it will be crucial in medical emergencies. Wide cover of ailments and situations with the least number of exclusions is ideal.
More often than not, the premium cost takes precedence over other considerations. Focusing primarily on its size can be misleading, as, in the long run, additional features like co-payment can be a drain on the pocket. Finding a balance between the allocated budget for health insurance, its draining clauses compensate in the long run, however, the cost of premium can be somewhat lowered through online purchase
Having covered the major aspects to consider while buying the best Health Insurance Plan in India, it is not out of place to check up on a summary of some useful tips for making a good purchase.
The above bullet points to consider before buying the best health insurance plan in India is practically a checklist. But, having such a wide choice of plans to consider, one is clueless about what is right. In such a scenario, understanding and learning some of the aspects in greater detail is the only way to compare among them and arrive at an informed choice. Thus, the following information is of utmost importance to find a suitable answer to the question posed.
The basic principle of Day Care has already been explained earlier. However, studying it in greater detail is imperative, considering its underlying importance in the modern age, where best health insurance is an intrinsic component of long term financial planning. The grouse about its impact is genuine, considering that standard health policies do not cover normal visits to the doctor, and bills for related medication entail huge financial drain. Yet, they are not included in standard health policies. It is opined that the cumulative cost of Day Care procedures, usually at a conservative estimate, is twice that of hospitalization cost. It is for the simple reason that medical technology advancements have resulted in redefining many treatment procedures, free from restrictions of 24 hours hospitalization. Thus, Day Care at the cost of repetition can be described as treatment procedures that require hospitalization for less than 24 hours Some of the common procedures in this category are chemotherapy, dialysis, cataract, tonsillectomy, radiation, and lithotripsy to name a few; With the IRDAI advocating more product innovations, the list is growing by the day. Here is a list of the common indicative procedures that find a place in the best health insurance today.
Some of the indicative Day Care procedures in India |
||
Sl No |
Category |
Procedures |
1 |
Nose |
Procedures are related to Turbinates, Excision, and treatment of infected nasal tissue, Nasal sinus aspiration, etc. |
2 |
Ear |
Surgery for the reconstruction of the middle ear and auditory Ossicles, Fenestration of inner rear, removal of tympanic drain and Tympanoplasty for the closure of eardrum perforation |
3 |
Orthopedics |
Arthroscopic knee aspiration, incision of bone – aseptic and septic, Osteosynthesis, suture and other procedures on tendons and tendon sheath |
4 |
Ophthalmology |
Cataract, incision of tear glands, excision and destruction of infected tissue of the eyelid, incision of the Cornea, Retinal detachment surgery, procedures involving Epicanthus and Canthus, foreign body removal from the Cornea, conjunctiva, eye lens, etc. |
5 |
Skin and Subcutaneous Tissue |
Skin transplantation and chemosurgery, revision of skin plasty, local excision or destruction of diseased skin |
6 |
Others |
Chemotherapy, Radiotherapy, Tonsillectomy, Lithotripsy, Auroplasty, Oncology, Neurology, Urology, Thoracic surgery, Gastroenterology, Stapedotomy, Myringotomy, Dialysis, etc. |
The advent of a clutch of insurers post liberalization of the insurance sector in 2000 has resulted in many innovative inclusions in the best mediclaim policy on the table. Few insurers embrace coverage for Outpatient Department (OPD), Dental and Maternity expenses that do not require overnight hospitalization and yet not included in Day Care. By nature, these entail small recurrent expenditures in comparison to costly Day Care procedures. The best health insurance plan for OPD typically pays pharmacy bills, besides consultation fees, diagnostic expenses, dental treatment, and maternity, often with sub-limits. However, such plans are few and far between. The basic reason is that the proportionate cost of the premium goes up substantially. Evaluating the cost-benefit ratio, it is evident that there are hardly any takers for such plans.
The incidence of lifestyle diseases is part and parcel of modern living. Diabetes, Cardiovascular, and Cancer are some of the common chronic critical illnesses, which afflict a vast cross-section of our society across all age range. Its management, in the short term in hospitals as well as in the long term care, costs a bomb and is a severe drain on the financial resources.
The incorporation of cover for critical illness was a natural progression in the best health insurance policies. It is not only a regular inclusion in best health insurance, which is a non-life insurance product but also offered as an optional rider in pure life insurance protection plans as well, generally referred to as Term Plans.
Apart from its cover in best medical insurance, as standalone critical illness plans, there are a host of unique health insurance plans, which cover specific diseases like Cancer and Heart. The basic difference in plans for critical illness and health insurance is in the claim process. While in the former, the sum insured is paid out in lump sum on diagnosis of the listed disease regardless of hospital expenses; in the latter, claim for expenses is routed through either cashless treatment or subsequent reimbursement on submission of documents. Like in Day Care, it is wise to check for the list of diseases covered or defined for a selection of the best health insurance in conformity of the health profile of the customer.
The list tabulated below is only indicative. It is proper to check the coverage with individual insurers.
Some of the indicative Critical illness covered in India |
|
Category |
Procedures |
Cancer |
Cancer of specified severity |
Heart and Artery benefit |
Angioplasty |
Heart Attack |
|
Heart Valve Surgery |
|
Artery Surgery |
|
Cardiomyopathy |
|
Primary Pulmonary Hypertension |
|
CABG |
|
Major Organ Benefit |
Blindness |
Chronic Lung Disease |
|
Chronic Liver Disease |
|
Kidney Failure |
|
Major Organ / Bone Marrow Transplant |
|
Brain and Nervous System Benefit |
Apallic Syndrome |
Brain Surgery |
|
Benign Brain Tumor |
|
Major Head Trauma |
|
Come |
|
Stroke with Permanent Symptoms |
|
Motor Neuron Disease with Permanent Symptoms |
|
Permanent Paralysis of Limbs |
|
Alzheimer’s Disease |
|
Muscular Dystrophy |
|
Multiple Sclerosis with Permanent Symptoms |
|
Poliomyelitis |
|
Parkinson’s Disease |
|
|
|
Others |
Loss of Independent Existence |
Loss of Limbs |
|
Deafness |
|
Loss of Speech |
|
Medullary Cystic Disease |
|
Systematic Lupus Erith with Renal Involvement |
|
Major Burns |
|
Aplastic Anemia |
This is an important aspect that is required to be well comprehended by the policyholder. There are standard inclusions as well as some special, which makes one plan different from the other, helping to choose the best health insurance. It is, in any case, absolutely imperative to be acquainted with the inclusions, both for cashless and reimbursement treatment. Some of the major components for particular attention are:
Usually, hospitals have General Beds or Cabin of different categories. Then there are ICU related charges, which are higher as compared to beds. The tariff varies according to the category. Best Health Insurance has variable measures for rent capping. Some insurers limit the maximum to fixed amounts for beds and ICU separately. While some employ a percentage of the sum insured to define the limits.
The lower the sum assured, the lower is the limit for bed rent. As an illustration, for a sum insured of Rs 5 Lakh, if the bed rent is defined as 1%, it comes to Rs 5000. If it is 2%, the rent is doubled to Rs 10000, but there is a catch. The cost of services incorporates hospitals that are linked to the category of beds and amount, impacting the final bill. It may result in paying the higher amount at the time of discharge in cashless and a lower reimbursement amount, subsequently.
It covers expenses covering the bed, boarding, consultation, diagnostic investigations of all types, OT charges inclusive of all medical equipment and appliances needed in surgery, surgeon and anaesthetist fee, medicines, medical consumables, physiotherapy and nursing charges.
Almost all best health insurance cover for this expense, which is limited to the number of days. Generally, it covers expenses of OPD type comprising Doctor's fees, Diagnostic expenses, Pharmacy bills up to 30 days before admission in a hospital.
All the expenses covered in Hospitalization and Pre Hospitalization are eligible in this category. Most of the insurers limit the period for cover to 60 days, while some extend it further to 90 days.
It is a situation where the patient is needed to be hospitalized but is compelled to be treated at home due to extraneous reasons, like unavailability of bed in the hospital, etc. The best health insurance covers it in India.
It is a facility common mostly in best health insurance policy, by, which the sum assured is reinstated after it is exhausted due to claim payments. It acts like backup recharging the sum assured to ensure that no future claim is repudiated due to poor balance. It is particularly beneficial in family floater accounts, where other members may be vulnerable if any one member has to make a claim. However, policyholders must understand that there are limitations to the benefit.
The treatment related to ambulance cover, vary from plan to plan. Some relate it to the quantum of sum assured, defining eligibility confined to higher amounts. Further to this, even the best Mediclaim insurance limits the maximum eligible expense. In the present day, where best health insurance globally accepted, Air Ambulance charges are also part of the eligible expense.
It is one of the essential facets of best health insurance in India is the range of exclusions in them, limiting the choice of policyholders. Some of the key parameters to consider are:
It is the period compulsorily excluded for acceptance of claim after the commencement of risk. The periods vary, with insurers and specific plans, but the industry standard is 90 days. In exceptional best medical insurance, the period can be lower, or from day one itself.
It is applied to specific covers for critical or terminal illness, from the date of diagnosis. It is defined as the waiting period after diagnosis of the listed ailment, for settlement of the claim as per agreed terms. The industry standard is 30 days, with exceptions of 15 days in select plans.
A pre-existing disease is defined as any medical condition, ailment, or injury that was already diagnosed and existed at the time of purchase of the best health insurance plan. However, recently IRDAI has clarified on 27th September 2019, that any ailment or disease diagnosed within 3 months of purchase of best health insurance plan, will be deemed as Pre-existing Disease (PED), in fresh guidelines for the standardization of health insurance. The norm applies to all health policies filed after 1st October 2019. However, for existing health contracts, the new norm will come into effect from 1st October 2020. Usually, the waiting period for cover extending to PED is 48 months. In some cases, it may be lower at 36 or 24 months. The general thumb rule applied to PED is:
A1. The uniform standard set of documents required across insurers is:
A2. There are two possible scenarios – Emergency Cashless Treatment or Planned Cashless Treatment. In both cases, the TPA desk in the Network hospital has to be intimated. They take the approval of the projected medical expenses, which is settled after final approval of the amount at the time of discharge from the hospital.
A3. Whether planned or emergency, the TPA has to be intimated about the hospitalization and treatment. After discharge from the hospital, within a specified time limit, the claim will be submitted in the prescribed format with original bills and hospital reports endorsed by them. The claim amount will be remitted after due verification and approval through NEFT.
A4. Yes, one can have more than one health policy. However, it is ideal to have a single health policy with additional top-up policy to augment the sum insured substantially.
A5. In the case of Critical Illness Insurance, the entire sum insured is paid on diagnosis of the listed ailment in a lump-sum, regardless of the hospitalization expenses, and the policy terminates immediately. In the case of health insurance, even after settling the claim, the policy does not terminate.
A6. Yes, all Diagnostic expenses in pre and post-hospitalization phases, as well as during in-patient treatment, are considered legitimate and entertained in the claim.
A7. The insurer is within its right to permanently put the ailment in the list of exclusion for the policyholder, for reasons of non-disclosure.
A8. Normally, group health insurance is provided by the Corporate Entities or Employers to their employees. Not only is the premium lower, but it also has many customized benefits and features added to it.
A9. Generally, most health insurance plans need to be renewed every year, even if the policy term is longer or there are lifetime renewal features.
A10. All insurers invariably have defined a free look period for cancellation and refund of premium. The normal period in most plans is 15 days.